Physician Burnout

Professional burnout has been making its waves for quite some time now. The ongoing pandemic and the evolving healthcare systems as well as changes in work environments have placed physicians at a high risk of burnout.

Among clinicians and those working within a healthcare setting, this is a vital concern due to burnout’s potential impact on the quality of patient care. Physician burnout over time results in declining satisfaction within the profession, leading to questions about whether patient care is truly a fulfilling experience that is truly worth caring about.

Very little is being done to evaluate and change the healthcare system to benefit physicians. This pandemic has highlighted how understaffed most of the global healthcare system is. This indicates a strain being inevitably placed on physicians to provide optimum care without reevaluating how this excess work is impacting their physical and mental wellbeing.

What is Physician Burnout?

The World Health Organization classifies physician burnout as a syndrome ¹. Burnout is observed following chronic stress within a professional setting. The three factors associated with physician burnout include:

• Exhaustion following continued stress within a work environment
• Negativity or cynicism concerning one’s job
• Inability to perform professional duties with optimum efficiency

After a substantial amount of time during which the stress builds up, physicians will note a detachment from their job. Work might often seem like a burden. The initial interest in patient care will slowly decline. As a consequence of burnout, the purpose with which most doctors enter into the profession is often lost.

An additional dimension to consider is the continuous requirement to cater to other people within a professional setting, which can often cause physicians to neglect their own health. Physicians frequently live up to the stereotype of having to be independent and self-sufficient when it comes to their health, making them more likely to ignore their need for assistance.

It is not always easy to recognize physician burnout. However, most often among colleagues, the loss of professional enthusiasm and the decline in the performance of patient care are indicative signs. Due to the subjective nature of burnout, paying close attention to colleagues, especially those who display such signs, can encourage early management of physician burnout.

Is Physician Burnout Increasing?

Burnout rates were already higher than ever before the pandemic started. The COVID-19 years only tipped these scales further.

Physician burnout, pre-pandemic (1974–2009) was reported as high as 75% among resident physicians and 45% among medical students². A study conducted during the pandemic highlighted burnout rates peaking to 86% among healthcare professionals within the wards and 66% among frontline workers³.

To cope with workplace burnout, a higher number of physicians are reported resorting to alcohol⁴ and substance abuse⁵. Sadly, as the last resort to an inability to cope with a stressful environment, even suicide rates⁶ among physicians are slowly escalating.

Physician burnout can also increase the chances of developing mental health conditions such as depression⁷ or anxiety. Often, since burnout remains unattended for extended periods, it causes symptoms to evolve and become debilitating, affecting both quality of life and work.

Several factors have contributed to the increase in physician burnout. The increased caseload, family responsibilities, and chaos within workspaces (worsened by COVID-19) have consistently played key roles in exacerbating burnout.

Over the past few years, the transition to electronic health recording systems⁸ and the introduction of technology within healthcare settings have also been seen as factors in physician burnout. While the technology is being built to ease workloads, its use often leaves physicians pressed for time and also confused about how to use new systems. This overall experience vastly contributes to emotional exhaustion and a desire to leave their jobs.

How Does Physician Burnout Affect Patient Care?

A survey conducted by healthtech company Wheel and research firm PureSpectrum observed 80% of their survey respondents reported their attending healthcare professionals appeared burned out⁹. A majority of these patients also felt the quality of their healthcare could have been impacted as a result of burnout.

Physician burnout often results from the continuous addition to the workload and constant exposure to death, grief, and ailments, impacting their mental health. Patients who come in following any of these incidents or who are already receiving care from a burned-out physician can experience a change in their physician’s demeanor as well as reduced attention paid to their current concerns. Patients might report it as a physician who “doesn’t listen” to their presenting signs. Some might relay it as their physicians not spending enough time explaining their diagnosis or management plan as comprehensively as they ideally would.

An increase in patient referrals to other specialists was noticed among burned-out physicians ¹⁰. Additionally, there is an increase in the cost of patient care incurred when it is neglected, as this neglects tends to lead to an overall increase in testing or re-evaluation.

Finally, it is possible for physicians to continue to provide optimum care despite being burned out professionally. This is where the Conservation of Resources theory might play out¹¹. According to this theory, physicians maintain a high threshold for systemic negligence to cater to physicians and continue to place patient care at the center stage neglecting their wellbeing in the process.

How to Prevent Physician Burnout?

Physicians rarely discuss situations of stress, primarily because their work environments are not conducive to do. This makes subjective reporting of burnout scarce.

The first step toward managing physician burnout is to acknowledge its existence.

Identifying burnout among physicians would include identifying physicians who constantly record stress or emotional fatigue with their work. Patients of physicians who note a decline in usual patient care and request to change their primary care physicians could also be indicative. Physicians might often have a cynical perspective on their daily tasks and relay an inability to feel the same spark as they once did with their job.

Often quick fixes such as providing incentives or time to destress during work hours are sought-after ways of managing burnout. However, few studies show such measures as effective — they tend to have only small impacts¹².

Strategies to reduce burnout should adopt methods that address the underlying cause of physician burnout at an organizational level. The best way to manage physician burnout was reported to incorporate both individual-focused as well as organizational-centric efforts¹³.

Overall, the key is to reduce stress levels within the work environment, which can impact patient care.

Regular Organizational Screening for Burnout and Other Struggles With Mental Health

It can be relatively easy to overlook physician burnout within the chaotic environment of a healthcare system. Often due to negligence on both the part of the physician and the system, it is relatively easy to sidestep a physician’s well-being. This neglect has been more evident during this pandemic. Physicians should be regularly screened for burnout, especially when hospitals or other clinical settings have observed an increase in their workload. Regular check-ins with physicians to understand how their administrative tasks can be made more seamless should also be considered.

Strategies To Incorporate Regulated Time Off and Self-care Routines

Doctors rarely opt for time off, mainly due to the nature of their work, round-the-clock schedules, and understaffing. Organizations should assist physicians to explore the various facets of their lives which also require attention outside of their career, such as their family, community, and personal interests. In addition to clocking out at reasonable hours, they should be encouraged to take some time off for their life outside their work to destress. Physicians can explore meditation, support groups, and various physical activities during this time, which they can adopt as a part of their self-care routines.

To be fully effective at enabling and encouraging physicians to take time off, major reorganization at a systematic level will be required to allow the medical institute to continue operating without physicians working more than their contracted hours.

Assistance With Electronic Health Records and Adoption of New Technology

One stressor for physicians is the limitation placed on their time with patients due to clerical and administrative tasks required by the adoption of technology. Having assistants to run these administrative tasks or work on transferring to new electronic health recording systems can limit the time doctors spend on them. Additionally, mundane tasks such as sending faxes, coordinating with other doctors, or scheduling tests should be taken up by assistants as well, freeing up time for patient care. This also makes a noticeable improvement in the quality of patient care.

Allocating Excess Workloads Equally Among Staff

Hospitals should increase the number of physicians who can work flexibly to cover the personal time all physicians should take. This would allow physicians to have more control over their time and decrease work hours before they are worn down and at risk of medical negligence. Physicians who feel they have more say with their schedules and actively observe a system catering to their personal needs are more likely to feel satisfied with their work and less likely to leave due to burnout.

Conclusion

This pandemic has placed a spotlight on physician burnout, a situation that has always been looming in the background. Due to the nature of the profession, physicians often show up with minimal complaints even though their mental and physical well-being could be pushing through a fragile state. To limit the shift of healthcare professionals away from clinical settings, it is crucial to understand their needs for a more holistic work environment catering to their needs as human beings. As a system, it is possible to re-evaluate how it is run and make crucial changes needed to facilitate the wholesome experience for physicians within their profession.

References

1 World Health Organization. (2019, May 28). Burn-out an “occupational phenomenon”: International Classification of Diseases World Health Organization News. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

2 IsHak, W. W., Lederer, S., Mandili, C., Nikravesh, R., Seligman, L., Vasa, M., Ogunyemi, D., & Bernstein, C. A. (2009). Burnout During Residency Training: A Literature Review. Journal of Graduate Medical Education, 1(2), 236–242. https://doi.org/10.4300%2FJGME-D-09-00054.1b

3 Giusti, E. M., Pedroli, E., D’Aniello, G. E., Stramba, B. C., Pietrabissa, G., Manna, C., Stramba, B. M., Riva G., Castelnuovo, G., & Molinari, E. (2020). The Psychological Impact of the COVID-19 Outbreak on Health Professionals: A Cross-Sectional Study. Frontiers in Psychology, 11, 1–9. https://doi.org/10.3389/fpsyg.2020.01684

4 Oreskovich, M. R., Kaups, K. L., Balch, C. M., Hanks, J. B, Daniel, S., Sloan, J., Meredith, C., Buhl, A., Dyrbye, L. N., & Shanafelt, T. D. (2012). Prevalence of Alcohol Use Disorders Among American Surgeons. The Archives of Surgery, 147(2), 168–174 https://doi.org/10.1001/archsurg.2011.1481

5 Brown, S., Goske, M. J., & Johnson, C. M. (2009). Beyond Substance Abuse: Stress, Burnout, and Depression as Causes of Physician Impairment and Disruptive Behavior. Journal of the American College of Radiology, 6(7), 479–485 https://doi.org/10.1016/j.jacr.2008.11.029

6 West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516–529 https://doi.org/10.1111/joim.12752

7 Becker, J. L., Milad, M. P., & Klock, S. C. (2006). Burnout, depression, and career satisfaction: Cross-sectional study of obstetrics and gynecology residents. American Journal of Obstetrics & Gynecology, 195(5), 1444–1449 https://doi.org/10.1016/j.ajog.2006.06.075

8 Collier, R. (2017). Electronic health records contributing to physician burnout. Canadian Medical Association Journal, 189(45), 1405–1406 https://doi.org/10.1503%2Fcmaj.109-5522

9 Wheel, & PureSpectrum. (August, 2021). What Happens When Clinician Burnout Enters the Patient Exam Room? Wheel Telehealth News https://explore.wheel.com/hubfs/Wheel%20-%20Consumer%20Survey%20Report%20FINAL.pdf

10 Mangory, K. Y., Ali, L. Y., Rø, K. I., & Tyssen, R. (2021). Effect of burnout among physicians on observed adverse patient outcomes: a literature review. BMC Health Services Research, 21(369–2021) https://doi.org/10.1186/s12913-021-06371-x

11 Hobfoll, S. E., Halbesleben, J., Neveu, J., & Westman, M. (2018). Annual Review of Organizational Psychology and Organizational Behavior, 5, 103–128

https://doi.org/10.1146/annurev-orgpsych-032117-104640

12 Panagioti, M., Panagopoulou, E., & Bower, P. (2017). Physician Work Environment and Well-Being, 177(2), 195–205 https://doi.org/10.1001/jamainternmed.2016.7674

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